"Outcomes of Elective Home Births: A Series of 1,146
Cases" by Lewis Mehl, M.D. et al. Journal of Reproductive
Medicine. November, 1977.

This study evaluates 1,146 homebirths that occurred in California.
Sixty percent of these births were attended by doctors or nurses and
forty percent by lay midwives. There is no difference in outcomes
between the two groups. The rate of complications at the births is very
low compared to California hospital birth averages. The mortality rates
are less than half the hospital rates and the C-section rate is 2.4%
(the current U.S. cesarean rate is 28%).

This study surveys incidence of neonatal mortality and low birth
weight in out-of-hospital births. It divides the 809 births surveyed
into two groups: 575 planned homebirths and 234 unplanned. The planned
homebirths were attended by direct entry midwives. The study concludes
that although unplanned homebirths have a significantly higher incidence
of low birth weight and neonatal mortality, the planned homebirths have
lower incidence of both low birth weight and mortality than do Kentucky
hospital births attended by physicians.

"Neonatal Mortality in Missouri Home Births, 1978-84" by
Wayne F. Schramm, M.A. et al. American Journal of Public Health. August
1987.

This study examines 4,054 Missouri homebirths, planned and
unplanned. The births were attended by a variety of caregivers:
physicians, certified nurse midwives, direct entry midwives and
"others". The study concludes that for planned homebirths
"no important difference" is found in neonatal mortality
compared to hospital births. The authors note that the Missouri
Midwives Association certified midwives have the best outcomes of all
the attendants in the study, including physicians.

"Having Babies at Home: Is It Safe? Is It Ethical?" by
Gerald Hoff, M.D. and Lawrence Schneiderman, M.D. Hastings Center Report. December, 1985.

This essay examines the ethical dilemma posed to the physician by
homebirth. Many physicians vigorously oppose homebirth, and the authors
examine the available data to determine whether this opposition is
ethical. They conclude that "homebirth does not present a clear
and present danger..." They suggest that since homebirth is
reasonably safe, it should not be prohibited.

This article gives a clear history of how the profession of
midwifery in the U.S. was almost obliterated by obstetricians despite
statistical evidence that the midwives were having better outcomes than
the physicians. The author shows that the same problems with rural and
indigent care existed then as they do now and points clearly to direct
entry midwifery as the solution.

This study compares matched populations of homebirths attended by
non-nurse midwives with hospital births attended by physicians. It
concludes that the midwife sample has significantly better maternal and
neonatal outcomes and attributes this fact to physicians' high rate
of intervention.

COPYRIGHT 1992 Association of Labor Assistants & Childbirth Educators
No portion of this article can be reproduced without the express written permission from the copyright holder.